Current Clinical and Medical Education

Early versus Late Tracheostomy in a Suburban Population: Clinical Profile, Complications, and Outcomes

Arjun Panicker — 2026-04-02

Background: Tracheostomy is one of the most frequently performed procedures in intensive care units (ICUs). Despite its common use, the optimal timing, patient selection, and impact on outcomes remain debated. There is limited data on tracheostomy practices in suburban Indian populations.

Aim: To study the clinical profile, indications, complications, and outcomes of tracheostomised patients in a suburban population.

Materials and Methods: This observational study included 50 patients who underwent surgical tracheostomy between January 2023 and January 2026 at Rajalakshmi Medical College, Sriperumbudur, Tamil Nadu, India. Data were collected on demographic profile, primary diagnosis, indication for tracheostomy, type and timing of procedure, duration of mechanical ventilation, ICU and hospital stay, complications, and outcomes at discharge and three months. Statistical analysis was performed using chi-square test, Student’s t‑test, and ANOVA; p<0.05 was considered significant.

Results: The mean age was 44.22±19.83 years, with male predominance (76%). Head trauma was the most common indication (58%). Early tracheostomy (≤7 days) was performed in 74% of patients and was associated with significantly shorter duration of mechanical ventilation (3.35±2.08 vs. 14.61±7.03 days), ICU stay (7.2±5.3 vs. 24.3±4.2 days), and hospital stay (24.97±19.59 vs. 41±15.36 days) compared to late tracheostomy (>7 days). Complication rates were lower in the early group (8.10% vs. 46.15%). At three months, 64.86% of early tracheostomy patients improved, whereas 61.53% of late tracheostomy patients expired (p=0.0001).

Conclusion: Early tracheostomy (≤7 days) is associated with reduced mechanical ventilation duration, shorter ICU and hospital stays, fewer complications, and improved three-month survival compared to late tracheostomy. In patients with an established need for prolonged airway support, earlier intervention is more rewarding than delayed management.

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Comparative Efficacy of Dexmedetomidine as an Adjuvant to Intrathecal Hyperbaric Levobupivacaine versus Ropivacaine in Spinal Anaesthesia: A Randomized Controlled Trial

Atul Kumar Singh — 2026-04-06

Background and Aims: The selection of optimal local anaesthetic and adjuvant combinations in spinal anaesthesia significantly influences clinical outcomes, particularly regarding block characteristics, hemodynamic stability, and postoperative analgesia. The objective of our study was to compare the efficacy and safety of dexmedetomidine as an adjuvant to intrathecal hyperbaric levobupivacaine versus ropivacaine in adult patients undergoing elective surgery.

Methods: A prospective, randomized, single-blind study was conducted involving 60 adult patients (ASA I-II) scheduled for elective surgeries under spinal anaesthesia. Participants were randomly allocated to receive either levobupivacaine 15 mg plus dexmedetomidine 10 μg (Group L, n=30) or ropivacaine 15 mg plus dexmedetomidine 10 μg (Group R, n=30). Primary outcomes included onset and duration of sensory and motor blockade. Secondary outcomes encompassed postoperative analgesia duration, hemodynamic parameters, and adverse events.

Results: Onset times for sensory (92.27±12.05 vs 93.57±11.16 seconds, p=0.666) and motor (326.93±19.03 vs 327.60±18.68 seconds, p=0.892) blocks were comparable between groups. Group R demonstrated significantly longer sensory block duration (334.83±18.73 vs 280.17±14.35 minutes, p=0.001) and postoperative analgesia (513.67±35.04 vs 416.50±37.65 minutes, p=0.001). Group L exhibited prolonged motor block duration (117.33±6.23 vs 111.47±5.88 minutes, p=0.001). Hemodynamic stability was maintained in both groups with minimal adverse events. Hypotension occurred in 16.7% of Group L and 20.0% of Group R patients (p=0.739), with no cases of bradycardia or other serious complications.

Conclusions: Both dexmedetomidine combinations provided safe and effective spinal anaesthesia with rapid onset characteristics. Ropivacaine-dexmedetomidine offers superior postoperative analgesia and sensory block duration, making it preferable for procedures requiring extended pain control. Levobupivacaine-dexmedetomidine provides longer motor blockade, suitable for surgeries demanding prolonged immobilization. The choice between combinations should be tailored to specific surgical requirements and patient recovery goals.

Keywords: Dexmedetomidine, Levobupivacaine, Ropivacaine, Spinal anaesthesia, Postoperative analgesia, Regional anaesthesia.

Frequency and Risk Factors of Red Cell Alloimmunization in Transfused Patients with Sickle Cell Disease and Sickle Cell–β Thalassemia: A Three-Year Retrospective Study from a Tertiary Care Centre.

Tenzing Yutchola Bhutia — 2026-05-01

Background: Red cell alloimmunization is a clinically significant complication of repeated transfusions in sickle haemoglobinopathies. Comparative data from eastern India remain limited.

Objectives: To determine the frequency of alloimmunization in transfused patients with sickle cell disease (SCD) and SCD with β-thalassemia, and to identify associated demographic and transfusion-related risk factors.

Materials and Methods: A retrospective observational study was conducted at KIMS, Bhubaneswar, from October 2022 to October 2025. A total of 148 patients (131 SCD, 17 SCD+β-thalassemia) with a clearly recorded indirect Coombs test (ICT) result were analysed. Demographic and transfusion data were retrieved from blood bank registers. Statistical analysis included chi-square, Fisher's exact, Mann-Whitney U tests, and binary logistic regression.

Results: The overall alloimmunization frequency was 12.2% (18/148). Rates were 11.5% in SCD and 17.6% in SCD+β-thalassemia (p = 0.437). Alloimmunization increased significantly with transfusion burden, from 2.3% after one transfusion to 31.6% beyond ten transfusions (χ² = 10.23, p = 0.017). On multivariable regression, age was the only independent predictor (OR = 1.045/year, 95% CI 1.008–1.085, p = 0.018).

Conclusion: Alloimmunization affects approximately one in eight transfused patients with sickle haemoglobinopathies at this centre. Transfusion burden and age are the principal determinants. Extended antigen phenotyping and prophylactic Rh/Kell matching are strongly recommended, particularly for patients anticipated to receive more than five lifetime transfusions.

Assessment of Diabetic Retinopathy And Its Association With Glycemic Control In Newly Diagnosed Diabetes Patients

Pradeep Misra — 2026-05-08

Introduction: Diabetes Mellitus Type 2 is a major health concern worldwide, with a high number of cases resulting in various types of complications affecting target organs like Brain, Heart, Kidneys, and Eyes with the eyes presenting as Diabetic Retinopathy (DR), which is nowadays becoming a reason of preventable blindness. Low glycemic control, ageing, and delay in the diagnosis have enhanced the risk of DR. The study highlights the significance of the screening process and the accurate management to help prevent the effects of DR

Methodology: This cross-sectional, hospital-based observational study was carried out over a one-year period in a tertiary care center in India to evaluate Diabetic Retinopathy and its association with glycemic control. 80 newly diagnosed adult patients with type-2 Diabetes Mellitus were enrolled after obtaining institutional ethical approval and informed consent. Participants underwent detailed clinical assessment, including demographic profiling, laboratory evaluation of glycemic status using HbA1c levels, and comprehensive ophthalmological examination for the detection and grading of Diabetic Retinopathy. Patients were categorized into retinopathy and non-retinopathy groups. Statistical analyses were performed to assess associations and identify predictors of Diabetic Retinopathy among newly diagnosed diabetic patients.

Result: Among the 80 newly diagnosed type-2 diabetic patients, Diabetic Retinopathy was observed in 44% (35/80), predominantly mild non-proliferative disease (40%), followed by moderate (31%), severe non-proliferative (20%), and proliferative retinopathy (9%). Age and gender did not differ significantly between groups (p=0.21; p=0.81). The duration of diabetes was longer in the retinopathy group (2.5 ± 0.4 vs 1.5 ± 0.3 months; p=0.058) but not significantly different. Multivariate analysis identified diabetes duration (OR 1.14; p<0.001), HbA1c (OR 1.28; p=0.0256), and age (OR 2.08; p<0.05) as significant predictors.

Conclusion: The study concluded that the Diabetic Retinopathy is a common finding even among newly diagnosed type 2 Diabetes Mellitus patients and is significantly associated with poor glycemic control. Higher HbA1c levels and increasing duration of diabetes emerged as independent predictors of Diabetic Retinopathy.

Clinical Profile and Determinants of Dry Eye Disease in Adults

Pradeep Misra — 2026-05-08

Introduction: Dry Eye Disease (DED) is the disorder which is identified with tear film instability, ocular surface inflammation, and neurosensory dysfunction, which results to discomfort and visual impairment. The occurrence hasvariation among different populations and enhances with age, lifestyle factors and different systemic disorders. Analysis of the clinical profiles and determinants are important for the diagnosis and management.

Methodology: This cross-sectional study conducted over one year in a tertiary care hospital in India evaluated the clinical profile and determinants of dry eye disease. Among 150 patients aged above 20 years attending the Ophthalmologyoutpatient department, 90 were diagnosed with dry eye. Detailed demographic, clinical, and systemic data were collected following informed consent. Diagnosis and grading were based on Schirmer’s test I, tear break-up time (TBUT), tear film thinning time (TTT), and tear meniscus height (TMH).

Results: Across 90 dry eye cases, the highest age-specific prevalence was observed in the 50–59-year group (26.67%), followed by 40–49 years (20.00%) and 60–69 years (18.89%), while younger adults aged 20–29 years contributed only 5.56%. Symptomatically, burning sensation (93.75%), blurred vision (92.11%), redness (90.00%), and itching (89.47%) predominated. Mild to moderate level of severity was observed with significant reduction in the quantity and the quality of tear for different parameters like Schirmer’s I, TBUT, tear meniscus height, and tear film thinning time.

Conclusion: The study had concluded that dry eye disease was commonly prevalent among mid aged individuals, associated with ocular surface symptoms like itching and other systemic comorbidities were present. Mostly cases varied from mild to moderate level of severity of dry eyes.

A comprehensive study on the morphometric analysis of the human femur with anatomical and clinical correlations

Rajeshwari Sadashiv Bhosale — 2026-05-09

Introduction: The femur bone is the longest and strongest bone, which is crucial for locomotion, transmission of weight and maintains stability. The morphometric characteristics are significant for the orthopaedic surgery, design of the prosthesis and identification of forensic details. The study aims to evaluate the femoral measurements and the establishment of the anatomical variations with clinical significance.

Method: This was a descriptive cross-sectional study which was conducted among 50 dry human femora, where the intact bones were only included. The digital Vernier caliper was used to take measurements, an osteometric table, and a goniometer. Data analysis was done by SPSS. The descriptive statistics and correlation analysis were performed with p < 0.05.

Result: The study findings showed that the diameter of the head and the neck parameter showed moderate variation, while the length of the femur showed low variation. The positive correlations were noted between the head diameter, neck diameter, intertrochanteric line length and the length of the femur. The regression model showed moderate fit with R² = 0.271, p = 0.001, along with 27.1% variance.

Conclusion: The study concluded that the significant morphometric variation in the human femur bone, with the diameter of the head as 41.83 ± 3.12 mm and the neck parameter showed moderate dispersion, while low variation was noted for the length of the femur.